Hair Loss in Women: Types, Causes, and Myths
Hair Loss is Devastating for Women
This article was written specifically for women. While there is no doubt there are many men who care very much about their hair loss, severe hair loss can be a devastating experience for a woman. The fact remains that bald women are not the norm. Bald(ing) men, on the other hand, have lots of company and it’s considered perfectly normal, if not sexy, for a man to have this condition. A bald man doesn't receive a second glance.
From the author’s personal hair loss ordeal and hence the endless hours of research to resolve the issue, it can be said that:
- one can find factual descriptions of the different types of hair loss but there are relatively few commonly accepted facts about the underlying causes of hair loss.
- there are far too many clueless doctors who really don’t know much about hair loss but pretend they do and a lot of hair loss “experts” who disagree.
- treatments for the problem are actually rather hit or miss affairs but there is an endless parade of “specialists” willing to sell you their newest miracle cure.
- in general, there are a massive amount of contradictions regarding the entire subject.
Despite all this, it is best to be informed of the facts that are out there, and the more a person suffering from hair loss reads and learns about the problem, the faster it will be to control or cure it. Of course, to understand hair loss, it is important to first understand how hair grows.
How Hair Grows
A human scalp has approximately 100,000 hair follicles; a person is born with the total number of follicles they will have throughout their life. Blondes typically have the most hair, averaging 140,000 hairs, brunettes and people with black hair about 110,000 hairs and redheads about 90,000 hairs. Hair grows about .3 to .4mm per day, 1/2 inch per month or approximately six inches per year.
While hair itself is made up of extruded, compacted dead cells, the scalp is composed of living follicles. Each hair follicle has four distinct phases it cycles through on a regular basis:
- Anagen is the active or growth phase (which can actually be subdivided further into the proanagen, mesanagen and metanagen phases). Approximately 85% of the scalp's hairs are in this phase at any one time. The phase for each anagen hair lasts from two to six years.
- Catagen is the transition phase in which hairs begin to break down and lasts from one to two weeks.
- Telogen is the resting phase in which hairs prepare to shed. Typically 10% to 15% of the scalp’s hairs are in this phase at any one time. This phase lasts from two to four months.
- Ketogen, an only recently recognized fourth phase, occurs between the Telogen and new Anagen phase (depicted in the 4th box, "Return to Anagen"). This new phase is the period during which the hair follicle appears empty until the new hair protrudes from the scalp.
A full cycle can last anywhere from two to seven years per follicle, and each follicle will complete between 10 to 20 cycles in a lifetime. But when hair follicles become stuck in the Telogen phase, unusual hair loss and/or thinning occurs. Losing 50 to 100 hairs per day is normal; losing over 100 hairs per day may indicate the presence of a hair loss problem.
Alopecia: The Official Name for Hair Loss
The general medical name for abnormal or excessive hair loss is alopecia. This term includes hair loss caused by any number of reasons, from genetics, to the environment, to disease. Reasons for hair loss range from the most simplistic and easily treatable to the very rare and incurable. Following are the most common types of hair loss:
• Androgenetic alopecia (AGA) is perhaps the most prevalent type of hair loss. This type is commonly known as female pattern balding (FPB). It is tied to hormone levels, specifically Dihydrotestosterone (DHT), and sometimes, but not always, has a distinct pattern. This type of hair loss does not ever return the hair to previous health.
• Effluviums are the second most common type of hair loss and are divided into three groups:
- Telogen effluvium (TE) is the most common type of effluvium seen by doctors. It is generally a diffuse loss of hair that occurs, for the most part, all over the scalp. The triggers for this type of hair loss are many and varied. The hair loss typically begins six weeks to three months after the trigger event, but hair eventually does grow back normally.
- Chronic telogen effluvium (CTE) is telogen effluvium which persists for months or even years, sometimes with no apparent trigger.
- Anagen effluvium is also a diffuse loss of hair but occurs much more quickly and can cause a person to lose all of their hair. Women who are going through chemotherapy typically lose their hair to anagen effluvium. Hair growth most always returns to normal after time.
• Traction alopecia is a hair loss condition caused by trauma to the hair follicles over time. Extremely tightly pulled ponytails, extensions and cornrows are examples of hairstyles likely to cause this type of hair loss. If the hairstyle is discontinued in time, hair will grow back normally.
• Alopecia areata (AA) is believed to be a symptom of an autoimmune disorder that occurs when a person’s immune system mistakenly attacks the hair follicles. Hair loss may result in clumps of hair falling out, leaving round, shiny, smooth bald spots on the scalp. If the hair loss causes a person to go bald, the disorder is then called alopecia totalis; hair loss over the entire body is referred to as alopecia universalis. Hair regrowth depends on the severity of the loss. For some people, hair will grow back within a matter of months or years while others may endure fluctuating hair regrowth and loss for the rest of their lives.
• Triangular alopecia, also known as temporal alopecia, is a condition sometimes visible from birth. Hair is either completely absent or extremely fine in patches near the temporal area. Hair never returns to the bald areas.
• Trichotillomania, also known as trichotillosis, is a type of hair loss caused by the urge to pull and twist hair from the scalp, sometimes unconsciously, leading to bald areas on the head. In some cases, those with the disorder will eat their own hair. It is a type of compulsive control disorder, affecting women more so than men. The causes of trichotillomania are not very well understood but are believed to be connected to stress or depression.
• Scarring Alopecia, also called cicatricial alopecia, refers to a collection of different hair loss disorders, each of which is fairly rare. Symptoms are also patchy hair loss but with such intense inflammation that hair follicles are irreversibly destroyed, leaving behind scar tissue and permanent bald areas of the scalp.
The Many, Many Possible Reasons for Hair Loss
Unfortunately, a hair loss problem is not always an easy problem to resolve as there can be many underlying, and sometimes multiple, causes - as the following fairly lengthy list shows:
- Child birth
- Trauma (such as a car accident)
- Long term emotional stress (possibly from a job or mental issues such as anxiety or depression)
- Major surgery
- Severe infection
- High fever
- Used in chemotherapy and radiation
- Used for: acne, blood thinning, cholesterol, convulsions/epilepsy, depression, diet, fungus, glaucoma, gout, heart problems, high blood pressure, hormonal conditions (including high-androgen index contraceptives), inflammation, mood swings, parkinson’s disease, thyroid disorders, ulcers, vaccinations and weight loss.
- Crash dieting
- Malnutrition or deficiency in certain nutrients such as iron, Vitamin A or Vitamin D
- An excess of iron, Vitamin A or Vitamin D
- Allergies to wheat, eggs, peanuts, dairy, seafood or soy
- Food poisoning
Genetics: female pattern baldness may run in a woman’s family thereby making her more susceptible to this type of hair loss.
- Endocrine disorders: lupus, hypothyroidism, hyperthyroidism, polycystic ovary syndrome (PCOS), diabetes, Hashimoto’s disease (thyroiditis), hypopituitarism, and hypothalamic disorders
- Nonendocrine disorders: liver disease, inflammatory bowel diseases (ie. Crohn’s disease), syphilis, liver and kidney failure, candida (yeast infection), and certain cancers (Hodgkin’s lymphoma and leukemia)
- Scalp infections (such as ringworm)
- Secondary syphilis
Chemical toxicity: exposure to chemical toxins or long term ingestion of heavy metals may induce hair loss. Even the toxins inhaled while smoking tobacco are now believed to increase the potential for hair loss.
Physical damage: actual injury to the scalp will cause hair loss, trichotillomania and hair treatments used incorrectly both being possibilities.
Natural life phases: menopause and aging may trigger hair loss in some women.
Myths Surrounding Hair Growth and Hair Loss
There are as many myths surrounding hair growth as there are hair loss. The following are some of the most popular:
- Brushing hair 100 strokes per day will improve circulation to the scalp and thereby cause hair to grow. This statement is only partially true. Until recently, hair experts discouraged women from brushing their hair. Now, it's believed that brushing hair with a natural boar bristle brush will improve the health of both scalp and hair - but 100 strokes isn't necessary. However, if hair is brushed when wet or with the wrong type of brush, it may actually damage the scalp and lead to hair loss.
- Pulling or combing hair frequently will make hair grow faster. Both of these activities can damage hair if done when the hair is wet. If done when the hair is dry, pulling or combing hair gently can help circulation to the scalp.
- Shaving all hair from your head will encourage hair to grow back thicker and healthier. Hair thickness and health is determined by genetics and nutrition, not whether you shave your head completely.
- Trimming your hair frequently will encourage it to grow. For the same reason the previous statement is not true. Hair itself is a "dead" substance and its growth is determined by other factors.
- Hanging upside down will improve circulation to the scalp and increase hair growth. Standing on one's head or hanging upside down may temporarily improve circulation to the scalp, but it will not increase hair growth. Improving circulation to your scalp does help maintain and improve its health but that can be more easily accomplished by brushing your hair with a natural bristle brush.
- A hat with magnets in it will improve hair growth. Magnetic fields close to the scalp will do nothing to increase the number of hair follicles or how fast hair grows - those factors are determined at birth.
- Sleeping with your long hair loose (versus in a plait) at night will encourage hair growth. Not true and, in fact, may be detrimental to your facial skin as oils from your hair will come in contact with your face throughout the night.
- Long hair can put a strain on roots and cause hair loss. Just not true.
- Shampooing too much can accelerate hair loss. Shampooing too often can lead to damaged hair but will not increase hair loss.
- Coloring and perming hair can cause hair loss. This statement in and of itself is not true if the treatments are done properly. Only in instances of very severe chemical processing will the hair be damaged down to the root thereby causing true hair loss. However, over-processing hair with excessive bleaching, aggressive brushing, perming, dyeing, straightening and even blow drying can severely damage hair over time, leading to breakage that may appear to be hair loss.
- Wearing hats too much can cause hair loss. This is not true for hats or wigs. Hats are actually advised in the summer to protect your hair and scalp from the sun. Wearing a hat that is tight also will not cause hair loss, or, per another myth, hair growth.
- Dandruff can cause permanent hair loss. False. While unsightly, dandruff is simply a sign that your scalp is irritated. While you should determine why it is occurring and work to correct the situation, dandruff itself does not cause hair loss.
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 Illustration reproduced from www.nanogen.co.uk with permission from copyright owners Pangaea Laboratories Ltd.
 With permission by Alan J. Bauman, M.D. - Hair Loss / Hair Transplant Expert, Bauman Medical Group, P.A.
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